Diagnosis of brain death

Machado, Calixto

doi:10.4081/ni.2010.e2

Cited by 55 publications

(44 citation statements)

References 106 publications

(61 reference statements)

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“…This mechanism results in lack of oxygenation to the brain, not by failure of the delivery system, but from end organ breakdown of the brain, at the capillary or tissue level. 5 …”

Section: Brain Death Physiologymentioning

confidence: 99%

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

et al. 2013

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The diagnosis of brain death is a complex process. Strong knowledge of neurophysiology and an understanding of brain death etiology must be used to confidently determine brain death. The key findings in brain death are unresponsiveness, and absence of brainstem reflexes in the setting of a devastating neurological injury. These findings are coupled with a series of confirmatory tests, and the diagnosis of brain death is established based on consensus recommendations. The drive to breathe in the setting of an intense ventilatory stimulus (ie, respiratory acidosis) is a critical marker of brainstem function. As a consequence, apnea testing is an important component of brain death assessment. This procedure requires close monitoring of a patient as all ventilator support is temporarily removed and PaCO 2 levels are allowed to rise. A "positive" test is defined by a total absence of respiratory efforts under these conditions. While apnea testing is not new, it still lacks consensus standardization regarding the actual procedure, monitored parameters, and evidencebased safety measures that may be used to prevent complications. The purpose of this report is to provide an overview of apnea testing and discuss issues related to the administration and safety of the procedure.

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“…This mechanism results in lack of oxygenation to the brain, not by failure of the delivery system, but from end organ breakdown of the brain, at the capillary or tissue level. 5 …”

Section: Brain Death Physiologymentioning

confidence: 99%

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

et al. 2013

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“…Rats also resumed spontaneous respiration, evidenced by ventilator dyssynchrony. Recurrent seizures and spontaneous respiration shows that surviving rats in the DHA group preserved a certain level of brain function and were not brain dead35. However, in the control group, none of the five surviving rats developed seizures until 135 min.…”

Section: Resultsmentioning

confidence: 91%

“…Therefore, a lack of response to these stimuli was evidence of complete loss of motor responses. Overall, 20 min CA placed rats in the control group into a deep unresponsive coma, a criterion for brain death35.…”

Section: Resultsmentioning

confidence: 99%

DHA-supplemented diet increases the survival of rats following asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation

Kim

Yin

Shinozaki

et al. 2016

Sci Rep

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Accumulating evidence illustrates the beneficial effects of dietary docosahexaenoic acid (DHA) on cardiovascular diseases. However, its effects on cardiac arrest (CA) remain controversial in epidemiological studies and have not been reported in controlled animal studies. Here, we examined whether dietary DHA can improve survival, the most important endpoint in CA. Male Sprague-Dawley rats were randomized into two groups and received either a control diet or a DHA-supplemented diet for 7–8 weeks. Rats were then subjected to 20 min asphyxia-induced cardiac arrest followed by 30 min cardiopulmonary bypass resuscitation. Rat survival was monitored for additional 3.5 h following resuscitation. In the control group, 1 of 9 rats survived for 4 h, whereas 6 of 9 rats survived in the DHA-treated group. Surviving rats in the DHA-treated group displayed moderately improved hemodynamics compared to rats in the control group 1 h after the start of resuscitation. Rats in the control group showed no sign of brain function whereas rats in the DHA-treated group had recurrent seizures and spontaneous respiration, suggesting dietary DHA also protects the brain. Overall, our study shows that dietary DHA significantly improves rat survival following 20 min of severe CA.

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“…Confirmatory tests may be divided into two groups: in those that demonstrate the cessation of cerebral blood flow (CBF) and those, which prove the absence of bioelectrical activity. In the countries in which confirmatory tests are recommended or eventually even required, the most often used ancillary test is electroencephalography (EEG), which has been reported to have a 90% sensitivity2. Other accepted electrophysiological tests rely on the evidence of the loss of evoked potentials17.…”

Section: Discussionmentioning

confidence: 99%

Gadolinium-enhanced magnetic resonance angiography in brain death

Luchtmann

Beuing

Skalej

et al. 2014

Sci Rep

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Confirmatory tests for the diagnosis of brain death in addition to clinical findings may shorten observation time required in some countries and may add certainty to the diagnosis under specific circumstances. The practicability of Gadolinium-enhanced magnetic resonance angiography to confirm cerebral circulatory arrest was assessed after the diagnosis of brain death in 15 patients using a 1.5 Tesla MRI scanner. In all 15 patients extracranial blood flow distal to the external carotid arteries was undisturbed. In 14 patients no contrast medium was noted within intracerebral vessels above the proximal level of the intracerebral arteries. In one patient more distal segments of the anterior and middle cerebral arteries (A3 and M3) were filled with contrast medium. Gadolinium-enhanced MRA may be considered conclusive evidence of cerebral circulatory arrest, when major intracranial vessels fail to fill with contrast medium while extracranial vessels show normal blood flow.

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Diagnosis of brain death

Cited by 55 publications

References 106 publications

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

Apnea Testing During Brain Death Assessment: A Review of Clinical Practice and Published Literature

DHA-supplemented diet increases the survival of rats following asphyxia-induced cardiac arrest and cardiopulmonary bypass resuscitation

Gadolinium-enhanced magnetic resonance angiography in brain death

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